| NPI | 1518357821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA LCSW88764) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA LCSW88764) |
| 101YM0800X Counselor Mental Health | |
| 104100000X Social Worker | |
| Enumeration Date | 2015-01-26 |
| Last Update Date | 2022-07-25 |